Pancho - KIR-MAX-08

Code: KIR-MAX-08
Mercy ID: V-02912-22
Encounter Date: 10/15/2008
Last: Kirby
First: Max
DOB: 07/25/2008
County: Gwinnett
Street: 4258 Pleasant lake Village Ln. # F
City: Duluth
State: GA

Zip

30096-

Cell

(404) 573-0763

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Ana Kirby	01/03/1983	Perú
Father	Dereck Kirby	12/08/1977	USA
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: F. Gomez
Data Entry: J. Manzo